MODULE 20 short answer questions

saq 1.

A 4 year old child presents to the emergency department after ingesting 4 of his grandmother’s 60mg modified release gliclazide tablets 30 minutes previously. This was a witnessed ingestion, and no other tablets were taken. The child is currently well. It is 4pm

The child has been in your department for 2 hours. At this stage the resident looking after the child informs you that the BSL is 5.6mmol/L.

Outline your disposition considerations.

Must include

Potential for delayed hypoglycaemia (up to 8 hours)

Therefore requires an extended period of observation.

As this will end at midnight, and overnight admission is appropriate

Question 2. (6 marks)

An hour later your resident informs you that the paediatrics registrar told her that as the child was well at 3 hours with a normal BSL he could be discharged. Subsequently the resident discharged the child.

What actions will you take?

Must include:

Recall of the child to the department immediately

Discussion with paeds consultant to ensure child is admitted with an appropriate monitoring regime

Quality assurance issues including education and procedure:

ED resident

Paeds registrar

Explanation and disclosure of events and rationale for recall to mother

Apology for inconvenience.

Question 3.

The child returns 2 hours later (7 hours after the original overdose). He is drowsy and partially responsive.

What investigation will you order?

Must include:Immediate BSL

Question 4. (4 marks)

The BSL returns at 1.6. Give two alternatives to managing this toxic ingestion.

saq 4.

A patient is brought into your hospital after collapsing at a local beach.

Question 1. (16 marks)

List six organisms that may have been responsible for envenomation of this patient. For each, list themajor mechanisms of toxicity.

Must include:(1 mark for each organism, 1 mark for each feature)

Box jellyfish

Large tentacle marks/severe pain at sting site

Neurotoxic/paralysis

Irukandji

Severe back pain

Symptoms of autonomic instability: sweating, hypertension, vomiting

Sea Snake

Paralysis

Mytotoxicity

Blue ringed octopus

Isolated Neurotoxicity

Cone shells

Isolated Neurotoxicity

Stone fish

Severe pain

Cardiotoxic venom

SAQ 5.

A 45 year old butcher is brought to your department unconscious after an apparent suicide attempt. He was found in his butcher store kitchen with an open packet of curing salt, and had left a suicide note.

His vital signs are:

HR 110 /minBP 96/45 mmhgRR 29 /minO2 sats 86% RAT 36.7 oC

On arrival an arterial blood gas is taken in the resuscitation room. The results are shown below.

pH 7.10PO2 105 mmHgCO2 32 mmHgHCO3- 16 mmol/LO2 sat 95%

Na+ 145 mmol/LCl- 109 mmol/L

Lactate 5.2 mmol/L

Your registrar notes a brown appearance to the patient’s blood.

Question 1. (5 marks)

What are the major disturbances in the arterial blood gas? Provide calculations to substantiate your answer.

Must include:

Raised anion gap metabolic acidosis with respiratory compensation

Expect CO2 = 32

AG = 20

DR = 1.0

Question 2. (2 marks)

What is the likely diagnosis and how will you confirm it?

Must include:Methaemoglobinaemia: check a methemoglobin saturation level(note, curing salt contains nitrites, and this patient has a low O2 sat compared to his O2 tension)